A 58 year old African-American woman, with Sickle cell trait is complaining of what she describes as "migraine" on the left side that has been getting worse over the last 10 days. She is obese (you notice she has trouble getting out of her chair), diabetic and she's been taking Glucophage, she is also hypertensive and she's taking Norvasc.
She states that she used to have regular migraines earlier in her life but "they stopped" right before she reached menopause. This time the "migraines are back" and they are so severe that she must stop whatever she's doing even eating is painful. (she's a tax preparer and she can not look at the computer screen anymore). No nausea or vomiting, examination reveals BP 155/90, and tenderness over the left side of scalp. Her father died from a stroke at 65 and her mother is 82 with a bypass surgery at 67.